Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study

We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empiric antibiotic therapy was adapted microbiological findings were available. The primary objective was to assess that FODP mini-BAL is more efficient than blood cultures to identify pathogens with the ratio of identification between both techniques as principal criteria.We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL, and in 11.1% of cases using blood cultures (p < 0.01). When patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL, and in 9.5% of cases using blood cultures (p<0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.FODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.